Development and validation of a prediction rule for recurrent vascular events based on a cohort study of patients with arterial disease: the SMART risk score
Development and validation of a prediction rule for recurrent vascular events based on a cohort study of patients with arterial disease: the SMART risk score
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DOI：
10.1136/heartjnl-2013-303640
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发表时间：
2013-06-01
期刊：
影响因子：
5.7
通讯作者：
van der Graaf, Yolanda
中科院分区：
文献类型：
--
作者：
Dorresteijn, Johannes A. N.;Visseren, Frank L. J.;van der Graaf, Yolanda
目的通过开发和验证基于血管危险因素的复发性血管事件风险预测模型，对患有各种类型动脉疾病的患者进行风险分层，研究设计：前瞻性队列研究，研究地点：大学医学中心，1996年1月至2010年2月，5788例患者因各种动脉疾病的临床表现而转诊。主要结局指标：结果3个考克斯比例风险模型预测10年复发性血管事件的风险是建立在年龄和性别以及临床参数（模型A）、颈动脉超声检查结果（模型B）或两者（模型C）的基础上的。临床参数包括病史、当前吸烟、收缩压和实验室生物标志物。在数据集的单独部分，模型A的一致性统计量为0.68（95% CI 0.64 - 0.71），而模型B为0.64（0.61 - 0.68），模型C为0.68（0.65 - 0.72）。模型A的拟合优度和校准是足够的，在患有冠状动脉、脑血管、外周动脉或血管疾病的患者的单独亚组中也是如此。模型A预测23%的患者有30%的复发风险。结论根据现有的临床特征，可以确定血管事件复发的高危患者。
Objectives To enable risk stratification of patients with various types of arterial disease by the development and validation of models for prediction of recurrent vascular event risk based on vascular risk factors, imaging or both.Design Prospective cohort study.Setting University Medical Centre.Patients 5788 patients referred with various clinical manifestations of arterial disease between January 1996 and February 2010.Main outcome measures 788 recurrent vascular events (ie, myocardial infarction, stroke or vascular death) that were observed during 4.7 (IQR 2.3 to 7.7) years' follow-up.Results Three Cox proportional hazards models for prediction of 10-year recurrent vascular event risk were developed based on age and sex in addition to clinical parameters (model A), carotid ultrasound findings (model B) or both (model C). Clinical parameters were medical history, current smoking, systolic blood pressure and laboratory biomarkers. In a separate part of the dataset, the concordance statistic of model A was 0.68 (95% CI 0.64 to 0.71), compared to 0.64 (0.61 to 0.68) for model B and 0.68 (0.65 to 0.72) for model C. Goodness-of-fit and calibration of model A were adequate, also in separate subgroups of patients having coronary, cerebrovascular, peripheral artery or aneurysmal disease. Model A predicted 30% risk in 23%.Conclusions Patients at high risk for recurrent vascular events can be identified based on readily available clinical characteristics.